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Please note that Attorney Bruzonsky has been doing this regular “Liens Corner” column since April 2006. His last “Liens Corner” article was for the November/December 2017 issue of The Advocate, having stepped down from this regular column, as he now works part-time (and is part-time retired) exclusively handling large subrogation/lien claims in very large personal injury and medical malpractice cases for other attorneys. However, attorney Bruzonsky may add notes to this website under the subject lien article headers from time to time. (Please keep in mind that this site contains general information for educational purposes only. It is not intended to provide legal advise, which can only come from a qualified attorney who is familiair with all the facts and circumstances of your specific case and relevant law.) 

 

 

2014-05/06: The Winters Case - AHCCCS Hospital Balance Billing

June 25th, 2016 11:35:36 am


This article has been published in “The Advocate”, a monthly publication of the Arizona Association for Justice/Arizona Trial Lawyers Association, May – June 2014 issue, @2014 by Steven J. Bruzonsky, Esq.

 

 

May/June 2014 Lien Updates

 

Hospital AHCCCS Balance Billing Litigation Status:

 

The Honorable J. Richard Gama, Maricopa County Superior Court, issued an Under Advisement Ruling on January 17, 2014, inWinters v. Banner Health Network, CV 2012-007665, granting Plaintiff’s Motion for Summary Judgment and denying Defendants’ Cross-Motion for Summary Judgment,  holding that federal Medicaid law prohibits AHCCCS balance billing by the hospitals, and that Arizona law which permits such balance billing and liens is preempted by federal Medicaid law.  Hospitals file liens with the County Recorder under A.R.S. §33-931 et seq and claim a lien against the injured patient’s personal injury or medical malpractice claim for the amount of the total medical bill less the amount paid by AHCCCS. A.R.S. §36-2903.01(G)(4) provides that a hospital may collect full payment from Medicaid and thereafter collect any unpaid portion of its bill from other third-party payors or in situations covered by A.R.S. §33-931 et seq. 45 C.F.R. §447.15 (formerly 45 C.F.R. §249.31) has long provided that “A State plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by the individual.” Also, 42 U.S.C. §1396a(a)(25)(C) provides that the healthcare provider in third party cases may not seek to collect from the patient (or financially responsible relatives, etc) “payment of an amount for that service (i) if the total of the amount of the liability of third parties for that service is at least equal to the amount payable for that service under the plan . . .” The Court rejected the hospitals’ contention that the enforcement of a health care provider lien is not balance billing because it is a collection from the third party tortfeasor, not from the Medicaid patient, citing Lizer v. Eagle Air Med Corp., 308 F. Supp. 2d 1006 (D. Ariz. 2004) (federal Medicaid law prohibits and preempts A.R.S. §33-931 et seq healthcare provider liens and balance billing for an air ambulance provider), and citing consistent decisions in other jurisdictions. A proposed Judgment has been filed. Obviously this decision will be appealed.



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Terms of Use: This site contains general information for educational purposes only. It is not intended to provide legal advise, which can only come from a qualified attorney who is familiar with all the facts and circumstances of your specific case and relevant law. If you use this site, or send information or e-mail the attorney, such action does not create an attorney-client relationship. For legal advise please personally consult with an experienced attorney like Steven J. Bruzonsky.